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Inspection on 06/07/05 for High View Lodge

Also see our care home review for High View Lodge for more information

This inspection was carried out on 6th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

High View Lodge offers a comfortable relaxed environment to its service users. The home is clean, pleasantly decorated and well maintained. Care practices observed were good and staff training is readily available. One service user stated `The staff are caring, helpful and friendly.` The manager has an open door policy to her office, which creates a positive ethos. Staff stated that they have a good relationship with the manager who is very supportive and always willing to assist with personal development.

What has improved since the last inspection?

The manager is currently introducing a Service User Guide for the respite service, as some information in the current guide is not applicable to the service users staying at the home on respite. The manager has undergone a massive recruitment drive and agency staff have rarely been used. A new supervision format has been introduced ensuring consistency and continuity. Care plans have been reviewed and staff have received training on recording. Staffing records have been updated and now contain all information required. The information is well organised and tools have been implemented to ensure that recruitment procedures are followed. A working group is being set up to promote a multi-disciplinary approach.

What the care home could do better:

Care plans could be further improved, as more detail would be more helpful.Staffing levels on the dementia care unit need to be reviewed in accordance with service users needs. The induction programme for new carers is three days. This appears to be insufficient in relation to the size of the home and the level of service users needs.

CARE HOMES FOR OLDER PEOPLE High View Lodge Cherry Orchard Gadebridge Hemel Hempstead, Hertfordshire HP1 3SD Lead Inspector Alison Jessop Unannounced 6 July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service High View Lodge Address Cherry Orchard, Gadebridge, Hemel Hempstead, Herts, HP1 3SD Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01442 239733 01442 239154 Runwood Homes Plc Jacqueline Smith CRH Care Home 77 Category(ies) of OP-77, PD(E)-77 registration, with number of places High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: There are none. Date of last inspection 30 January 2005 Brief Description of the Service: High view Lodge is a purpose built residential care home which can up to 77 service users. The home is divided into four units, one of which is a specialist dementia care unit. There is also an additional respite unit. Each unit has a lounge and dining area and there is a large communal lounge at the front of the home. Bedrooms are single occupancy however couples can be accomodated if necessary. All bedrooms have en-suite facilities. High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced inspection over one day. The atmosphere in the home was relaxed, warm and welcoming. Service users were observed ambling around talking to staff and visitors. Feedback was gained from several service users, visitors and staff. What the service does well: What has improved since the last inspection? What they could do better: Care plans could be further improved, as more detail would be more helpful. High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 6 Staffing levels on the dementia care unit need to be reviewed in accordance with service users needs. The induction programme for new carers is three days. This appears to be insufficient in relation to the size of the home and the level of service users needs. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the above standards were inspected on this occasion. EVIDENCE: Standard six is not applicable, as the home does not provide Intermediate care. High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 &10 The manager and staff have clearly improved service user care plans since the last inspection report and care can now be delivered in accordance with the service users plan. EVIDENCE: Staff have received in house training on recording care plans. Although information in the care plans has clearly improved these could further benefit more detail. An example of this is the information given in the family tree and social history, an in depth history is essential when providing care to service users who have dementia. Tools used to review a person’s care needs include the Modified Barthel Index and the Mental Status Questionnaire. Although risk assessments are available, they have not been reviewed. Nutritional fluid charts were not satisfactorily completed. One service user who has very high care needs has been referred for ‘Nursing Care’. The home currently continues to provide care to this lady who is bedfast until a Nursing placement becomes available. The service user appeared to be comfortable and well cared for. Evidence suggests that she receives regular and appropriate care, however some gaps in recording were found. It was High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 10 recommended that daily notes include a more detailed description of care given. Interaction observed between staff and service users suggest that service users are treated with dignity and respect. Care practices were appropriate and sensitive to peoples needs. High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14,& 15 More appropriate methods of service user consultation could be used in order to ensure that service users choices and preferences are gained. EVIDENCE: An activity co-ordinator has been employed and has introduced a new activity programme, which was due to be displayed on each unit. Activities planned on the day of the inspection included music and movement, sing-along and a fish and chips night. Forthcoming events include a Caribbean night. The respite unit ensure that rehabilitation tasks such as making tea are included during the day. Newspapers and books were available on the units and service users were observed listening to the radio or watching television during the inspection. Minutes of service user meetings, information on display boards and other quality assurance systems suggest that service users are consulted with, however feedback from service users suggests that these methods are ineffective or inappropriate to the service users abilities. One service user said ‘There is not a lot of choice or suitable activities. It would be good to have choices and the opportunity to say no thank you.’ Menu choices were available and on display in most of the units however there appeared to be a lack of information available to service users on the dementia unit. On this unit the notice board did not display the day and date, activities High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 12 or menu. On the day of the inspection the menu choices were roast chicken with potatoes and vegetables or salad. Food served looked appetising. High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 &18 Although a Complaints Procedure is available and complaints made are recorded, some complaints had not been ‘closed’. Thus giving the impression that the complaint had not been fully resolved. EVIDENCE: Four complaints had been received since the last inspection report, three of which were in relation to the cleanliness of the lounge used by the service users on respite. Due to the regular change over of service users and the use of this room for activities the room had become unclean. A deep clean has since taken place and cleaning hours have been increased. The room on the day of the inspection looked clean and no further complaints have been received. One other complaint remained outstanding, although the complainant had written to the home withdrawing the complaint, this had not been recorded as resolved. The manager must ensure that all complaints received are fully resolved and evidence recorded. An external Advocacy service had been facilitated for one service user who had raised some concerns. One service user said that he would feel confident about making a complaint and would know who to talk to. The homes recruitment polices and practices had been followed to ensure that service users are safeguarded from abuse. Staff confirmed that they are aware of the Whistle-blowing procedure and the Hertfordshire Protection of Vulnerable Adults Procedure. High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,23,24,25 & 26 The home offers a pleasant, comfortable and safe environment to its service users. The home is clean and well maintained and bedrooms are personalised offering a homely, lived in feel. EVIDENCE: The home offers a pleasant, relaxed environment to its service users. The rooms are attractively decorated and feel light and airy. The home looked clean and well cared for and no malodours were present on the day of the inspection. The garden offers a large open space for service users. New patio furniture has been provided. The garden would benefit from a regular maintenance programme. A requirement has been made for the carpet in Gade View Lounge to be replaced as it is heavily stained. It was recommended that one of the small High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 15 dining tables in The Leas is covered and/or replaced. One new shower hose also requires replacement. High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 The level of staffing on the specialist dementia care unit appears to be inadequate. This demonstrated a lack of ‘specialist’ care provided. EVIDENCE: On the day of the inspection there was a full permanent staff compliment. One staff member is used to float around all units and offer assistance during busy periods to the two carers working on each unit. The absence of staff over a substantial period of time in the dementia care lounge area was recognised. Two staff members on the unit were observed taking a break. Interaction or intervention with service users did not occur during this time, demonstrating inadequate levels of care and supervision to a highly vulnerable group. Service users were complimentary about the staff and management of the home. Stating ‘ the staff are caring, helpful and friendly’. The home employs rigid recruitment procedures. All recruitment files contained required information and the manager had introduced new monitoring tools, which ensures that all documentation is present. The induction programme for new carers is three days. This appears to be insufficient in relation to the size of the home and the level of service users needs. Staff spoken to have received appropriate training, much of which is carried out in house. Staff spoken to confirmed that they receive regular supervision High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 17 and found the managers training sessions very helpful. The manager will be introducing an appraisal system in the near future. High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32, 33, 35, 36, 37 & 38. The manager continues to have a positive impact on the home, her office ‘open door policy’ creates a positive ethos to service users and staff. EVIDENCE: Many new policies and procedures have been developed since the last inspection report and generally all recording systems appear to have improved. Quality assurance procedures include a suggestion box, a service user questionnaire, resident’s notice board, residents meetings and events feedback sheets. The manager stated that residents meetings have been ineffective and unconstructive, therefore a representative from each unit will attend a meeting on their behalf and anything discussed with actions will be fed back. There is one outstanding requirement from the last inspection report in relation to the availability of the companies Financial Plan. The manager stated that High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 19 she does not currently have access to this and does not have responsibility for budget setting. This remains an outstanding requirement. On the day of the inspection the fire alarms were being tested. One fire extinguisher is required to be re-fitted to the wall. Each unit has a small kitchenette where light snacks and drinks are available. Fridge/freezer temperatures had not been recorded in accordance with food hygiene regulations. Although new patio furniture has been provided, there are no umbrella’s or other methods of providing shade to service users. High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 2 3 3 x 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 3 3 3 3 2 x 3 3 2 High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 7.4 16 Regulation 15 (2)(b) 22(3) Requirement Risk Assessments included in care plans must be reviewed monthly. The registered person must ensure that any complaint made under the complaints procedure must be fully investigated and any action recorded. The carpet in Gade View Lounge must be replaced. The registered person must ensure that at all times appropriate numbers of staff are present in each unit as appropriate to the needs of the service users. Staff breaks must be organised so that adequate staffing numbers remain on the unit at all times. Adequate sunshade must be provided to service users using the garden furniture. Timescale for action By 31/7/05 and henceforth By 31/7/05 and henceforth By 31/10/05 By 31/7/05 and henceforth 3. 4. 19 27 23(2)(d) 18(1)(a) 5. 27 23(2)(o) By 15/7/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 22 High View Lodge 1. 2. 3. 4. 5. Standard 14.1 15.7 19 30 34 The registered manager should explore more affective methods to maximise service users capacity to exercise personal autonomy and choice. A copy of the menu should be available in formats to suit the capacity of all service users. The worn dining room table located in The Leas dining room should be covered until it can be replaced. The registered person should ensure that new staff receive an adequate induction. The buisness and financial plan should be available for inspection. This remains outstanding from the previous inspection report. High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City, Herts AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI High View Lodge I52 s19423 High View Lodge v237167 060705 Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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